Aims:To investigate initial Sequential Organ Failure Assessment (SOFA) score of patients in Intensive Care Unit (ICU), who were diagnosed with infectious disease, as an indicator of multiple organ dysfunction and to examine if initial SOFA score is a better mortality predictor compared to Simplified Acute Physiology Score (SAPS).Materials and Methods:Hospital-based study done in medical ICU, from June to September 2014 with a sample size of 48. Patients aged 18 years and above, diagnosed with infectious disease were included. Patients with history of chronic illness (renal/hepatic/pulmonary/  cardiovascular), diabetes, hypertension, chronic obstructive pulmonary disease, heart disease, those on immunosuppressive therapy/chemoradiotherapy for malignancy and patients in immunocompromised state were excluded. Blood investigations were obtained. Six organ dysfunctions were assessed using initial SOFA score and graded from 0 to 4. SAPS was calculated as the sum of points assigned to each of the 17 variables (12 physiological, age, type of admission, and three underlying diseases). The outcome measure was survival status at ICU discharge.Results:We categorized infectious diseases into dengue fever, leptospirosis, malaria, respiratory tract infections, and others which included undiagnosed febrile illness, meningitis, urinary tract infection and gastroenteritis. Initial SOFA score was both sensitive and specific; SAPS lacked sensitivity. We found no significant association between age and survival status. Both SAPS and initial SOFA score were found to be statistically significant as mortality predictors. There is significant association of initial SOFA score in analyzing organ dysfunction in infectious diseases (P < 0.001). SAPS showed no statistical significance. There was statistically significant (P = 0.015) percentage of nonsurvivors with moderate and severe dysfunction, based on SOFA score. Nonsurvivors had higher SAPS but was not statistically significant (P = 0.094).Conclusions:Initial SOFA score is a superior mortality predictor. It easily measures degree of organ dysfunction in infectious diseases and complements other scoring systems.

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Objective: To analyze if leucocyte count could aid the diagnosis of malaria and if it could help in judging the severity and thus the prognosis. Material and Method: Out of 374 patients admitted to a tertiary hospital with history of fever, 100 subjects diagnosed with malaria were included for the study. Other causes of fever were excluded. Relevant hematological profile was done and patients were categorized to those with leucopenia (<4000cells/mm 3 ), leucocytosis (>11000cells/mm 3 ) and normal count. The results were compared by chisquare test (x 2 ). Results: Of the 69 subjects with vivax malaria, 21.7% had leucopenia while 7.2% had leucocytosis and of the 31 subjects with falciparum malaria, 16.2% had leucopenia while 6.45% had leucocytosis. Presence of leucopenia particularly in vivax malaria was significantly associated with anemia (p< 0.001) and thrombocytopenia (p<0.0027) when compared to those having leucocytosis and those with normal leucocyte count. Conclusion: Whether leucopenia can prove to be a predictor for vivax malaria needs further large scale studies. However we propose leucopenia may be considered along with anemia and thrombocytopenia in prognosticating, particularly vivax malaria.

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Objective:To assess the occurrence and severity of acute renal failure in hospitalized malaria patients. Patients and Methods: In a hospital based set up out of 400 cases of fever, 102 were detected with positive malarial parasite. Clinical history and assessment were recorded in all the study patients and all other known etiological causes of fever and jaundice were excluded by relevant investigations. The renal function test including both Blood urea and serum creatinine was done for the patients.Acute Renal Failure(ARF): Those with serum creatinine >1.5 mg% and normal size kidneys on USG were included in ARF and further divided in 3 groups: mild (Scr < 2 mg%), moderate (Scr 2-5 mg%) and severe (Scr>5mg%). Result: Of total 102 malaria positive patients, Plasmodium falciparum was seen in 6 patients (5.88%), plasmodium vivax in 46(45.09%) and mixed infection in 50patients (49.01%). Eleven patients (10.78%) out of 102 patients had ARF and malarial positive. Plasmodium falciparum was the causative agent in 1; P.vivax in 3 and mixed infection in 7 patients. Out of 102 patients two patients had severe renal failure with creatinine values more than 5mg/dl. 89.22% of patients with malaria had serum creatinine below 1.5mg/dl. Conclusion: It can be concluded that in south kanara region it is the mixed and plain P.vivax which was more common.ARF occurs commonly in plasmodium falciparum malaria but in our study it has been reported in mixed & plasmodium vivax.